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Vulvar and Anal Intraepithelial Neoplasia: Terminology, Diagnosis, and Ancillary Studies.

Abstract Currently, it is recognized that there is an HPV-related and an HPV-independent pathway to developing squamous cell carcinomas (SCC) in the anus and vulva. The majority of precursor lesions and SCC in the anus and vulva are high-risk HPV-associated, with HPV16 the most common type. Given the morphologic overlap and biological equivalence of HPV-related preinvasive squamous lesions of the lower anogenital tract, a unified, 2-tiered histopathologic nomenclature is now recommended. In contrast, mutations in the TP53 gene have been associated with HPV-independent vulvar and anal SCC. A precursor lesion-differentiated or simplex vulvar intraepithelial neoplasia (dVIN)-has been identified for HPV-independent vulvar SCC but a similar lesion in the anus has not been described. Extramammary Paget disease is a nonsquamous intraepithelial lesion of the vulva and anus that may be a primary epidermotropic apocrine neoplasm or may represent secondary involvement by a synchronous/metachronous adenocarcinoma. This entity may be mimicked by squamous lesions and melanocytic lesions. Herein, we discuss the morphologic and immunohistochemical features of anal and vulvar intraepithelial neoplasia in the context of updated terminology and current understanding of disease biology.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title advances in anatomic pathology
Publication Year Start




PMID- 28398952
OWN - NLM
STAT- MEDLINE
DA  - 20170411
DCOM- 20170418
LR  - 20170418
IS  - 1533-4031 (Electronic)
IS  - 1072-4109 (Linking)
VI  - 24
IP  - 3
DP  - 2017 May
TI  - Vulvar and Anal Intraepithelial Neoplasia: Terminology, Diagnosis, and Ancillary 
      Studies.
PG  - 136-150
LID - 10.1097/PAP.0000000000000149 [doi]
AB  - Currently, it is recognized that there is an HPV-related and an HPV-independent
      pathway to developing squamous cell carcinomas (SCC) in the anus and vulva. The
      majority of precursor lesions and SCC in the anus and vulva are high-risk
      HPV-associated, with HPV16 the most common type. Given the morphologic overlap
      and biological equivalence of HPV-related preinvasive squamous lesions of the
      lower anogenital tract, a unified, 2-tiered histopathologic nomenclature is now
      recommended. In contrast, mutations in the TP53 gene have been associated with
      HPV-independent vulvar and anal SCC. A precursor lesion-differentiated or simplex
      vulvar intraepithelial neoplasia (dVIN)-has been identified for HPV-independent
      vulvar SCC but a similar lesion in the anus has not been described. Extramammary 
      Paget disease is a nonsquamous intraepithelial lesion of the vulva and anus that 
      may be a primary epidermotropic apocrine neoplasm or may represent secondary
      involvement by a synchronous/metachronous adenocarcinoma. This entity may be
      mimicked by squamous lesions and melanocytic lesions. Herein, we discuss the
      morphologic and immunohistochemical features of anal and vulvar intraepithelial
      neoplasia in the context of updated terminology and current understanding of
      disease biology.
FAU - Yang, Eric J
AU  - Yang EJ
AD  - Department of Pathology, Stanford University School of Medicine, Stanford, CA.
FAU - Kong, Christina S
AU  - Kong CS
FAU - Longacre, Teri A
AU  - Longacre TA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Adv Anat Pathol
JT  - Advances in anatomic pathology
JID - 9435676
SB  - IM
MH  - Anus Neoplasms/diagnosis/*pathology
MH  - Carcinoma in Situ/diagnosis/*pathology
MH  - Carcinoma, Squamous Cell/diagnosis/*pathology
MH  - Female
MH  - Humans
MH  - Papillomavirus Infections/diagnosis/pathology
MH  - Precancerous Conditions/*pathology
MH  - Vulvar Neoplasms/diagnosis/*pathology
EDAT- 2017/04/12 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/12 06:00
AID - 10.1097/PAP.0000000000000149 [doi]
AID - 00125480-201705000-00003 [pii]
PST - ppublish
SO  - Adv Anat Pathol. 2017 May;24(3):136-150. doi: 10.1097/PAP.0000000000000149.

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